The operative treatment of Jacksonian and focal epilepsy / by Charles Beylard Nancrede.

  • Nancrede, Charles B. (Charles Beylard), 1847-1921.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: The operative treatment of Jacksonian and focal epilepsy / by Charles Beylard Nancrede. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    October 4, 1888, after the usual preliminaries, an area of bone was re- moved by the trephine to reach a spot where the membranes were not attached to the brain. The old and new bone orifices were made one by removal of the intervening bridge of bone. The cicatrix in the scalp was found to be continuous with a dense scar, blending mem- brane and cortex into one mass over the lower two-thirds of the motor area for the right side. This scar was carefully removed with the knife, the thumb-centre was located by electricity and excised. The electrical excitement, despite profound anaesthesia, caused a typical paroxysm. After removal of the centre none could be in- duced by application of the electrode to its former site. Recovery ensiled, leaving only some weakening of the thumb and inability to perform some of the more delicate movements of the hand. This man, leaving the hospital on the twenty-fourth day, later went South, married, and supported a family by manual labor, but, unfortunately, at the end of about two and a half years—for the exact details were not sent me—recurrence took place. What lessons should the course pursued by this case teach us? First, that our predecessors were correct in attributing- cer- tain forms of epilepsy to the irritation of nerves by cicatrices either of bone or soft parts, and that in this case an excision of the painful scalp cicatrix—pressure upon which induced a fit commenc- ing upon the same side as that of injury which conclusively demon- strated that the convulsions could not be of cortical origin—was the proper treatment, not a blind removal of bone and replace- ment of the same, thereby providing a new source of irritation The history further shows that the first operation, entailing pro- onged irritation from the presence of the necrosing bone, caused he formation of so much granulation tissue that scalp mem- ranes, and cortex became fused, and a “ surgical epilepsy” was manufactured, which affected the opposite side primarily and was thus now of cortical origin. Are all the lessons exhausted ? o, or the result of my operation shows that the crradUal con eCT, tl,e eW dCal,iX and irritation crfthe brain tually caused a recurrence of the disease, and that in similar “rS T ^ deViSCd t0 P-™* adhesion fo ,: - xxtczz - —-